IM and PC Bleeding

Question 1

IM and PC Bleeding Definition

Answer 1

IMB- bleeding other than PC at any time other than normal menstruation, sometimes difficult to discern from menorrhagia
PCB- after intercourse
Breakthrough- Irregular bleeding on hormonal contraception

Question 2

IM and PC Bleeding Epidemiology

Answer 2

-14% of pre-menopausal women experience

Question 3

PC Bleeding Aetiology

Answer 3

• Infection
• Ectropion
• Polyps
• Vaginal cancer
• Cervical cancer
• Trauma or abuse
• Vaginal atrophic change

Question 4

IM Bleeding Aetiology

Answer 4

• Pregnancy-related
• Physiological (e.g. at ovulation)
• Vaginal causes; adenosis, vaginitis, tumours
• Cervical causes; infection (STI), cancer (bleeding most often PC, polyps, ectropion)
• Uterine causes (fibroids, endometrial polyps, cancer)
• Ovarian cancers
• Iatrogenic causes

Question 5

IM and PC Bleeding Diagnosis

Answer 5

• History and examination

- Bimanual pelvis examination

Question 6

IM and PC Bleeding Ix

Answer 6

• Always exclude pregnancy and STI
• Bloods
• USS, biopsy, colposcopy may be indicated

Question 7

IM and PC Bleeding Management

Answer 7

Treat cause

-High rate of spontaneous resolution